COMPLICATIONS OF PREGNANCY 2.
Ultrasonography (Ultrasound or Sonogram):
 Complications of pregnancy are health
problems that occur during pregnancy. They
can involve the mother's health, the baby's
health, or both. Some women have health
problems that arise during pregnancy, and
other women have health problems before
they become pregnant that could lead to
complications.
Two scenarios when pregnancy can be at high risk:
1. If she has pre-existing conditions that put
her at risk of complications;
2. When complications occur suddenly in an
otherwise healthy pregnancy.
High-Risk Pregnancy:
 when fetus face higher chance of
experiencing problems
 causes can be:
a. pre-existing maternal conditions
b. factors in pregnancy
c. maternal concurrent disorders
d. external factors and more
 Often occurs in >40 and <18 years old mothers
Identifying and Monitoring
High-Risk Pregnancy:
1. Alpha-fetoprotein (AFP) Enzyme Blood Test:
 protein produced in the liver of a
developing fetus. During a baby's
development, some AFP passes through
the placenta and into the mother's
blood.
 measures the level of AFP in pregnant
women during the 2ND trimester
 The amount of AFP in the blood of a
pregnant woman can help see whether
the baby may have such problems as
spina bifida and anencephaly
 for detecting neural tube (brain and
spine) defects in the fetus
 also used to detect pregnancy with
twins
 often used with ultrasound and
amniocentesis for cross diagnosis
 a prenatal test offered to most pregnant women
 uses sound waves to show a picture of
the baby in the uterus (womb)
 helps your health care provider check on
your baby's health and development
 first 20 weeks of gestation: full bladder is
needed for better visualization
 after 20 weeks’ gestation: a full bladder
is not necessary
 Nursing Care:
1. encourage fluids and refrain mother from
voiding before the test
3. Chorionic villi Sampling (CVS):
 supplies same data as amniocentesis but
can be done earlier and quicker results
can be obtained
 Nursing Care:
1. instruct to drink fluid (usually 30mins
before) so that the bladder is full
2. after the test:
- monitor for uterine contractions
- vaginal discharge
- teach how to observe signs of infection
4. Amniocentesis:
 procedure used to take out a small
sample of the amniotic fluid for testing
 Amniotic fluid:
- fluid that surrounds the fetus in the
womb
- clear, pale, yellow fluid
- protects the fetus from injury and
against infection
 checks for sex, fetal age, fetal lung
maturity, AFP, biochemical defects,
genetic or chromosomal condition, such
as Down's syndrome, Edwards' syndrome
or Patau's syndrome
 Test is done after sonogram; usually after
15-18 weeks gestation
 Nursing Care:
1. have client void
2. after test:
- monitor for: uterine contractions
and vaginal discharge
- test for signs of infection
3. encourage rest
 Amniocentesis
5. Nonstress Test (NST):
 usually done when a health care
provider wants to check on the health
of the fetus, such as in a high-risk
pregnancy or when the due date has
passed
 checks to see if the baby:
a. responds normally to
stimulation
b. gets enough oxygen
 is a continuous FHR monitoring
 usually done after ultrasound
 RESULTS:
a. Reactive (Normal)
o Before week 32:
- 2 or more acceleration of FHR
of at least 15bpm for at least
10sec each within a 20min
window/interval
o Week 32 or after:
- 2 or more acceleration of FHR
of at least 15bpm for at least
15sec each within a 20min
window/interval
o NO INTERVENTION NEEDED
b. Nonreactive
o No FHR in less than 15sec
o NEEDS FURTHER MONITORING
c. Nonsatisfactory
o NST cannot be interpreted
 Nursing Care:
1. fasting is not necessary
2. observe the fetal monitor
3. explain test to the mother to ↓ anxiety
4. evaluate response to procedure
Nonstress Test (NST):
(https://nursinglecture.com/non-stress-test-nst/)
6. Contraction Stress Test (CST):
 also called as “oxytocin challenge test”
 performed near the end of pregnancy
(≥34 weeks' gestation) to determine
how well the fetus will cope with the
contractions of childbirth
 aims to:
a. induce contractions
b. monitor the fetus to check for
FHR abnormalities via
cardiotocograph
 To test, at least 3 contractions of ≥40sec
duration within 10 minutes are observed
 RESULTS:
a. Negative: No late or significant
variable decelerations
b. Positive: Late decelerations
following ≥50% of contractions,
even if there are <3 contractions
in 10 minutes
c. Equivocal - suspicious:
intermittent late or variable
decelerations with < 50% of the
contractions.
d. Equivocal - hyperstimulatory:
Decelerations with contractions
occurring more frequently than
every 2 minutes or lasting >90s
associated with excessive uterine
activity
e. Unsatisfactory: <3 contractions in
10 minutes or uninterpretable
FHR tracing
  Nursing Care:
1. void before test
2. monitor FHR for 30 minutes before test
3. monitor mother after test to observe
for possible initiation of labor
4. evaluate response to procedure
https://www.momjunction.com/articles/contraction-stress-
test-during-pregnancy_00367783/
7. Biophysical Profile (BPP) Test
 determines the health of the baby (fetus)
during pregnancy
 may include a nonstress test with
electronic fetal heart monitoring and a
ultrasound
 measures: baby's heart rate, muscle
tone, movement, breathing, and amt. of
amniotic fluid around your baby
 used for fetus that may have intrauterine
compromise
 Nursing Care:
1. provide emotional support
2. evaluate response to procedure
8. Maternal Assessment of Fetal Activity:
 need to contact physician or nurse
midwife when there are:
- < 10 fetal movements in a 12hr period
- < 3 fetal movements in an 8hr period
- no fetal movements in the morning
 Used to determine vitality of fetus
 Nursing Care:
1. teach mother to record and report movements
9. Fetal Scalp pH Sampling:
 may be done during labor when fetal
heart patterns begin to indicate distress
 capillary blood samples are taken from
fetal scalp in utero
 RESULTS: if acidosis is present,
immediate birth of infant is indicated
 Nursing Care:
1. cleanse vaginal area to avoid contamination
during test
1ST DISORDER: HEMORRHAGIC COMPLICATION
1. Complication r/t pregnancy
2. Diseases not r/t preg. but occurs coincidentally
COMPLICATIONS:
a. Abortion
b. Incompetent Cervix
c. Ectopic Pregnancy
d. Hydatidiform Mole
e. Abdominal Pregnancy
f. Placenta Previa
g. Abruptio Placentae
h. Disseminated Intravascular Coagulation
ABORTION
 Abortion is the termination of a pregnancy by
removal or expulsion of an embryo or fetus
(at any time before age viability).
 An abortion that occurs without intervention
is known as a miscarriage or "spontaneous
abortion" and occurs in approximately 30% to
40% (10-20% according kan ma’am) of
pregnancies.
 Abortion is a medical term for the disruption
of a pregnancy before the fetus reaches its
viable age of more than 20 to 24 weeks of
gestation or weighs at least 500g.
I. PATHOPHYSIOLOGY
 The most common cause of an abortion is
abnormal fetal development, which is either
due to a chromosomal aberration or a
teratogenic factor.
 Another common cause is the abnormal
 implantation of the zygote, where there is
inadequate endometrial formation or the
zygote was implanted on an inappropriate site.
This would cause inadequate development of
the placental circulation, leading to poor
nutrition of the fetus and eventually, to an
abortion.
 Other common causes:
1. Presence of organ defects
2. Trauma
3. Maternal disorders (pre-existing,
concurrent, or gestational)
- High blood pressure
- Diabetes
- Kidney disease
- HIV
- Malaria
- Gonorrhea
- Syphilis
- Thyroid gland problem
- Lupus
4. External mechanical factors (Illegal
abortion)
5. Genetic defects
- Blighted ovum (occurs when an
early embryo never develops or
stops developing, is resorbed and
leaves an empty gestational sac)
- Intrauterine fetal demise
- Complete molar & partial molar
pregnancy
lead to abortion.
 Infection. In infection, the fetus would fail to
grow and estrogen and progesterone
production would fall. This would lead to
endometrial sloughing, then prostaglandins
would be released leading to uterine
contractions and cervical dilatation along with
expulsion of the products of pregnancy.
 Age. If the mother is >40 y.o or ≤18 y.o. For
primigravida (first time mothers), >35 y.o.
- Age 35 = 30% risk of abortion
- Age 40 = 40% risk of abortion
- Age 45 = 80% risk of abortion
 Weight. Overweight and underweight (<50kg
prepregnancy weight); Poor pregnancy
weight gain
 Invasive Prenatal Tests. Amniocentesis &
Chorionic Villi Sampling
 Consecutive 2 or more abortions.
 Uterine or Cervical Problem. Ex.: incompetent
cervix.

III. RISK FACTORS

 Congenital Structural Defect. This structural
defect may be due to chromosomal
aberration or a serious physical defect.
 ↓ Progesterone. Progesterone maintains the
decidua basalis. If the corpus luteum fails to
produce enough progesterone, it would risk
the life of the fetus inside the uterus.
 Rh Incompatibility. The fetus could get
rejected from a mother’s body if they have an
incompatible Rh.
 Undernutrition. Lack of nutrients would
cause undernourishment to both the mother
and the fetus, leading to abortion.
 Teratogens. Smoking, alcohol drugs, chemical
intoxication or substances cause congenital
disorders in a developing embryo or fetus.
 Drugs. There are drugs which are
contraindicated for pregnant women.
Ingestion might compromise the fetus and

III. TYPES
 Spontaneous abortion.
- Occurs mostly in 2ND mo. of pregnancy
- Very common (occurs in approximately
30% to 40% of pregnancies)
- Through natural causes
- Therapeutic management: Induced
abortion if required depending on the
symptoms & description of the bleeding
 Threatened abortion.
- embryo is already viable and products of
conception are still intact
- CERVIX IS CLOSED but there is vaginal
bleeding or spotting present
- Progresses to inevitable abortion if the
cervix progresses to open, can result to
bleeding or no bleeding
- Pregnancy with twins: usually only one
survives
- Signs/Symptoms:
o Scant and usually bright red bleeding
o Slight cramping
- Diagnostic Tests:
1. FHR & USG
2. Blood test for human chorionic
gonadotropin (hCG) hormone – If
placenta is still intact, level of hCG in the
bloodstream should double after 48hrs
from the onset of bleeding. Otherwise,
poor placental function will be suspected
and pregnancy can be lost
- Interventions:
a. Avoiding strenuous activity for 24-48hrs.
b. Explain about miscarriage and its causes to
prevent stress and guilt (as most women
believe in myths about its causes such as
taking the stairs, getting angry to a child,
etc.)
c. Teach coitus to be avoided for 2 weeks to
avoid further inducing the bleeding
 Inevitable/Imminent abortion.
- embryo is dead but some products of
conception either intact or expelled
- CERVIX IS ALREADY OPEN/DILATED and
there is presence of vaginal bleeding (also
increases)
- Bcs of open cervix, expulsion of POC
(products of conception) cannot be
stopped anymore
- Symptoms: Cramping or Contractions
- Further diagnostic tests: Besides the prior
tests done to determine threatened ab.,
tissue test will be analyzed for
abnormality such as hydatidiform mole
- Intervention. If no FHR is detected and
USG reveals an empty uterus or nonviable
fetus, D&C or D&E is performed to make
sure all POC (products of conception) are
removed to clean the uterus and prevent
infection.
- ULTRASOUND (USG) RESULT:
Gestational sac is intact
 Incomplete abortion.
- embryo is dead
- cervix is already dilated and there is
severe vaginal bleeding
- bcs of open cervix, there is expulsion of
some POC but some are retained
- ULTRASOUND (USG) RESULT:
Gestational sac is not intact
 Complete abortion.
- ALL POC ARE EXPELLED (fetus,
membranes, placenta) without any
assistance and the embryo is dead.
- cervix is dilated and there is mild bleeding
but usually slows for about 2hrs and stops
after a few days
- Intervention: Advise woman to report
heavy bleeding if it occurs
- ULTRASOUND (USG) RESULT:
No POC left in the uterus
 Missed abortion.
- embryo is already dead while inside the
uterus (retained)
- All POC are retained & the CERVIX IS
CLOSED
- Usually no signs or symptoms. Painless
vaginal bleeding (brown vaginal
discharge) may occur rarely
 o
- Diagnostic tests: Missed ab. is usually t
discovered during prenatal exams when
i
fundal height reveals no progress and no n
FHR is heard. t
- Intervention: D&C/D&E if preg. is not over 14 a
weeks. Otherwise, prostaglandin suppository c
or misoprostol (Cytotec) will be introduced to t
Open/Closed
COMPL All No POC left
the cervix to cause dilation, along with
ETE ex
oxytocin to cause contractions and expulsion
pe
of POC. lle
- Complication: If fetus/POC is retained too d
long in the uterus, disseminated intravascular MISSE Some expelled; fetus
Clos Fet
coagulation (Coagulation/Bleeding defect) D e retained
may develop. Woman can be intoxicated as d
well as have infections, leading to septic
abortion.
MNEMONICS
- USG RESULT:
Closed Cervix Dilated Cervix
Fetus and POC are retained. Abortion Abortion
(MTCCC) (IID)
 Septic abortion. M – Missed I – Inevitable
- any abortion, spontaneous or induced, T – Threatened I – Incomplete
that is complicated by uterine infection, C – Complete D – Dilated
including endometritis C – Closed
C – Cervix
- can be caused by use of nonsterile
IV. SIGNS AND SYMPTOMS
techniques for uterine evacuation after
1. Vaginal spotting. Vaginal spotting appears as
induced or spontaneous abortion
small brownish to reddish spots of blood
coming out of the woman’s vaginal opening.
 Recurrent/Habitual abortion.
This usually occurs when the cervix slightly
- Abortion becomes recurrent once the
dilates because the woman may have tried to
woman has had 3 or more consecutive
lift heavy objects or mild trauma to the
miscarriages at the same gestational age
abdomen occurred.
2. Vaginal bleeding. Bleeding is a serious
 Illegal Abortion.
occurrence during pregnancy because it
- Abortion outside medical settings/facility might indicate that the cervix has opened and
products of conception might be expelled.
DIFFERENCES IN TYPES OF ABORTION (summary)
3. Cramping/sharp/dull pain in the symphysis
Type Cer POC US pubis. This could occur on both sides and
v could be caused by trauma or premature
i contractions that might cause cervical
x dilation.
THREAT Clos Intact
POC intact
4. Uterine contractions felt by the mother.
ENE e Uterine contractions can be false or true, but
D d either of the two could be alarming during
INEVIT OpeIntact/expelled Ges. Sac
intact
the early stages of pregnancy because it could
ABL n expel the contents of the uterus thereby
E leading to abortion.
INCOMP OpeSome expelled; Ges.
LETE n S
a V. DIAGNOSTIC TESTS
c  Pregnancy test. This is to confirm the
pregnancy first if vaginal bleeding occurs. If
n test turns out negative, then the woman
 would be subjected to other diagnostic tests
that could confirm the nature and cause of
the vaginal bleeding. If it is positive, then
abortion would be considered and it would be
classified according to the presenting signs
and symptoms.
 Ultrasound. The safest and confirmatory test
for pregnancy, the ultrasound would be able
to confirm if the pregnancy is positive, and
also confirm if the products of conception are
still intact.
 Pelvic Exam.
 Monitoring/Assessing FHR.
 Blood Test.
 Tissue Test. Tissues expelled from the uterus or
brought with bleeding or vaginal discharge will
be tested. It cab test if aborting has occurred.
VIII. Nursing Diagnosis
 Chromosomal Test. If recurrent abortion occurs.
VI. MEDICAL MANAGEMENT
Aside from our own nursing management,
physicians would also have to order a
series of therapeutic management for
the pregnant woman.
 Administration of intravenous fluids. Such as
Lactated Ringer’s, IV therapy should be
anticipated by the nurse as well as
administration of oxygen regulated at 6-
10L/minute by a face mask to replace
intravascular fluid loss and provide adequate
fetal oxygenation.
 Avoid vaginal examinations. The physician
would also avoid further vaginal examinations
to avoid disturbing the products of
conception or triggering cervical dilatation.
 The physician might also order an ultrasound
examination to glean more information
about the fetal and also maternal well-being.
VII. NURSING ASSESSMENT
 The presenting symptom of an abortion is
always vaginal spotting, and once this is
noticed by the pregnant woman, she should
immediately notify her healthcare provider
 As nurses, we are always the first to receive
the initial information so we should be aware
of the guidelines in assessing bleeding during
pregnancy.
 Ask of the pregnant woman’s actions before
the spotting or bleeding occurred and
identifies the measures she did when she
first noticed the bleeding.
 Inquire of the duration and intensity of the
bleeding or pain felt. Lastly, identify the
client’s blood type for cases of Rh
incompatibility.
 Asses Vital Signs
 Asses the amount of bleeding (pad/hr); If
there is too much bleeding, IV may be needed
 Asses the woman’s pain, Sedative may be needed
 Emotional response to loss
 Detailed health and pregnancy history
 Assess the nature of blood loss
o Pain (from back towards the front/abdomen)
o Cramps (dull, sharp pain)
o Dizziness
o Amount and type of bleeding
 Risk for deficient fluid volume related to
bleeding during pregnancy
 Anticipatory grieving r/t loss of expected infant
 Pain r/t uterine complication
IX. Nursing Interventions
 If bleeding is profuse, place the woman flat in
bed on her side and monitor uterine
contractions and fetal heart rate through an
external monitor.
 Also measure intake and output to establish
renal function and assess the woman’s vital
signs to establish maternal response to blood
loss.
 Measure the maternal blood loss by saving
and weighing the used pads.
 Save any tissue found in the pads because this
might be a part of POC and they should be
tested.
 Measures to alleviated fear and anxiety
 Continue to monitor VS
 Incomplete abortion: Administer oxytocin
 Inevitable & Incomplete abortion: Surgical
removal of retained POC (D&C/D&E) only if
fetus is confirmed dead
 Missed Abortion: Usually POC are waited to be
expelled. If POC do not pass after about 2- 4wks,
abortion is induced
X. Evaluation
 The aim for evaluation is inclined towards
restoring the maternal blood volume and
stopping the source of the bleeding.
  Maternal BP: >100/60 mmHg 2. Previous cervix surgery.
 Maternal pulse rate: <100bpm 3. Short cervix.
 FHR: 120-160 bpm 4. Damaged uterus from previous miscarriage
 Maternal urine output: >30 mL/hr, and only or childbirth.
minimal bleeding should be apparent for not 5. Exposure to diethylstilbestrol
more than 24 hours. (DES), a synthetic (human-
 Expected outcome: made) hormone given to
a. Client remains free from complications some women in the past to
b. Client expresses feelings on the experience help them have successful
https://nurseslabs.com/abortion/ pregnancies.

II. SYMPTOMS OF INCOMPETENT CERVIX

INCOMPETENT CERVIX
 During pregnancy, the cervix is closed at the
lower end. It thins and opens before
childbirth. When it opens too early in a
pregnancy, it is called incompetent cervix
 Also known as “cervical insufficiency”.
 Complications linked to incompetent cervix
can include premature birth and miscarriage.
 Doctors diagnose most cases after a
miscarriage in the second trimester of
pregnancy.
 According kan ma’am discussion:
- Incompetent cervix have no signs but once
the complication starts, the ff. may be
experienced:
o Sensation of pelvic pressure
o Spotting (pinkish vaginal discharge)
o Sudden backache
o Mild abnormal cramps
o Change in vaginal discharge
III. MANAGEMENT AND TREATMENT
 The most common treatment for incompetent
cervix is a procedure called a cerclage. The doctor
will sew a stitch around the weakened cervix to
make it stronger. This reinforcement may help
the pregnancy last longer.
 TWO TYPES OF CERCLAGE:
1. McDonald’s CC (cervical cerclage):
Stitching the cervix with a nylon material
2. Shirodkar CC: Using sterile surgical tape
 Both success rates of McDonald’s and Shirodkar
CC is about 80%-90%.
 After the cerclage surgery, patient should remain
on bed rest (slight or modified Trendelenburg
position) to decrease the pressure on the new
sutures.
 Usual ADL and coitus is possible after CC.

https://www.abclawcenters.com/practice-areas/prenatal-birth/injuries/
premature-birth-and- prevention/incompetent-cervix/

I. CAUSES
1. Abnormally formed uterus or cervix.

VII. RISK FACTORS FOR INCOMPETENT CERVIX
 Doctors usually perform a cerclage at 12 to 14
weeks (2-3mo.) of pregnancy. The stitches are
typically removed around week 37 (upon last
month of pregnancy).
 Doctors do not use a cerclage if pregnant with
twins or multiples. Research shows no
improvement in the risk for preterm delivery
when doctors use this treatment on mothers
carrying more than one baby.
 Sometimes doctors discover an incompetent
cervix or cervix that has dilated significantly late
in the pregnancy. In these cases, the doctor may
recommend bed rest for the remainder of the
pregnancy.
 Progesterone (hydroxyprogesterone caproate)
supplement may be administered weekly.
IV. NURSING CARE
 Maintain bed rest for 24 hours after cerclage
 Monitor for rupture of membranes or
bleeding
 Repeated USG for monitoring of the fetus and
uterus
 Prevention:
- Regular prenatal care
- Healthy diet
- Healthy weight
- Avoid risky substances (teratogenic)
V. NURSING ASSESSMENT
 Assess patient’s pain
 Assess for painless bleeding
 Look for signs/symptoms of spontaneous
miscarriage
 Inspire/Teach mother to be follow do’s and
don’ts to prevent complications
VI. COMPLICATIONS ARE ASSOCIATED WITH
INCOMPETENT CERVIX
 Incompetent cervix can cause complications
including miscarriage and premature birth.
 In rare cases, a cerclage may involve
complications including:
o Rupture (sudden bursting) of the uterus.
o Internal bleeding.
o Laceration (cut or tear) on the cervix.
o Infection.
Women at higher risk for incompetent cervix
include those who have:
 An abnormally formed cervix or uterus.
 History of a premature birth or miscarriage
in the second trimester of pregnancy.
 Injured the cervix or uterus during previous
pregnancy or childbirth.
 Had cervical surgery in the past.
 Uterine/Cervix been exposed to DES
(Diethylstilbestrol)
 Cervical trauma such as excessive Papsmear
test in the past
 Race (Usually back individuals are affected)
 History of repeated D&C
 Congenital condition: uterine abnormality,
genetic disorder
 Increased maternal age
VIII. NURSING INTERVENTIONS
 Measures to alleviate/decrease anxiety
 Monitor VS and physical response to
incompetent cervix and CC
 Convey empathy to build a therapeutic
patient-nurse relationship
 Provide accurate information
IX. EVALUATION
 Patient verbalizes satisfaction and shows
decreased anxiety
ECTOPIC PREGNANCY
 An ectopic pregnancy most often occurs in a
fallopian tube (FT), which carries eggs from
the ovaries to the uterus. This type of ectopic
pregnancy is called a “tubal pregnancy”.
 Sometimes, an ectopic pregnancy occurs in
other areas of the body, such as the ovary,
abdominal cavity or the lower part of the
uterus (cervix), which connects to the vagina.
 Ectopic pregnancy cannot proceed.

I. RISK FACTORS
 Damage to the fallopian tube causing
blockage or narrowing so the eggs cannot
move into the uterus
 Previous pelvic infection
 Chlamydia (common STD that can cause
infection)
 Previous appendicitis
 Women with a history of infertility (Stabile,
1996)
 Caesarean section
 Women aged 35 or older
 Smoking
 History of ectopic pregnancy
 Inflammation/Infection
 History of tubal (fallopian tube) surgery
 Choice of birth control (IUD/lateral tubal
ligation)
II. SYMPTOMS
 Early signs of normal pregnancy
 Sharp abdominal pain: this is usually one-
sided, but not necessarily the side of the
ectopic pregnancy
 Bleeding that could be just spotting or
abnormal bleeding. The blood is often darker
than a normal period and can be described as
‘watery or prune juice colored’. Bleeding is
not the cause of the pain
 Sharp, stabbing pain at the lower quadrant
 Once leaking, shoulder tip pain may be felt,
which can be caused by irritation to the
diaphragm caused by internal bleeding, and
is a classic sign of ruptured ectopic pregnancy
 Bladder and bowel problems: pain when
going to the toilet and a feeling of pressure in
the bowels (urger to move bowels)
 Dizziness, pallor and nausea
 Collapse
 Vaginal bleeding after ectopic pregnancy
ruptures bcs of tearing of blood vessels
 Pelvic pain
III. MANAGEMENT
 Ultrasound scan (to locate where the fertilized
egg is located), pregnancy test and blood test
should be performed.
 Laparoscopy
1. Salpingostomy:
- creation of an opening into the
fallopian tube (FT)
- Ect. Preg. is removed and FT is left
to heal
2. Salpingectomy:
- surgical removal of one or both FTs
- Ect. Preg. and FT both removed
 Laparatomy: For emergency surgery when
there is excessive bleeding
 If diagnosis is made early before the tube
ruptures, keyhole surgery or drug treatments
such as methotrexate can be offered.
 Pelvic exam
IV. NURSING INTERVENTIONS
1. Assess continuously for signs of shock;
administer blood transfusion if ordered for
excessive blood loss
2. Administer analgesics as ordered for pain
3. Provide emotional support
4. Provide preoperative and postoperative care
5. Administer RhoGAM to Rh-negative client
6. Monitor VS and input & output
V. NURSING ASSESSMENT
 No unusual symptoms
 Assess the weeks of pregnancy: After 6-12
weeks of ectopic pregnancy with no
intervention, trophoblast will be large enough
to rupture the FT
 Assess for bleeding bcs blood vessels might be
affected by ectopic pregnancy
VI. NURSING DIAGNOSIS
 Risk of deficient fluid volume r/t bleeding
 Powerlessness
V. EVALUATION
1. Maintain hemostasis (body's natural reaction
to an injury that stops bleeding and repairs
the damage)
2. States implications for future childbearing
 3. Expresses feelings
4. Stops bleeding & Blood loss is replaced
5. Normal urine output: 30-60mL/hr
6. Normal Gravity of urine: 1.010-1.021
7. VS: Normal
8. Moist mucous membranes
VI. COMPLICATIONS
 FT bursts open
HYATIDIFORM MOLE (MOLAR PREGNANCY)
 Also known as “Gestational trophoblastic
disease (GTD)”, is the degeneration and
abnormal proliferation of the trophoblastic villi.
The cells become filled with clear fluid, giving
them the appearance of grape-like vesicles.
 An abnormal pregnancy in which there is a
benign growth of the chorion
 Spontaneous expulsion usually occurs
th
between the 16 and 18 week
 Rare muscle growth in the uterus during preg.
TYPES OF GTD:
1. Complete Molar Pregnancy
- Swelling of all chromosomal villi tissue
- Forms fluid (cystic)
- Embryo dies early if started to form,
resulting to no fetus development
- Mole has normal 46XX or 46XY BUT ONLY
CONTRIBUTED BY THE FATHER (indicating
that an empty ovum is fertilized and
chromosomal materials were only
duplicated, not from the mother)
- Often leads to choriocarcinoma
2. Partial Molar Pregnancy
- Multi-irregular tissue
- Fetus can develop but cannot survive
- Abortion occurs early
- Partial mole has 69 chromosomes
(69XX or 69XY) bcs of triploid
formation, meaning 3 chromosomes
instead of 2 for every pair – 1
chromosome from the mother & 2
from the father
- Rarely leads to choriocarcinoma
PATHOPHYSIOLOGY
 Fertilization occurs as the sperm enters the
ovum. In instances of a partial mole, two
sperms might fertilize a single ovum.
 Reduction division or meiosis was not able to
occur in a partial mole. In a complete mole,
the chromosome undergoes duplication.
 The embryo fails to develop completely.
There are 69 chromosomes that develop for
the partial mole, and 46 chromosomes for the
complete mole.
 The trophoblastic villi start to proliferate
rapidly and become fluid-filled grape-like
vesicles.
RISK FACTORS
This incidence happens in 1 of every 1, 500
pregnancies. There are risk factors that could
precipitate the formation of hydatidiform mole,
and they are as follows:
 Low protein intake. Women with low protein
intake have a possibility of developing a
hydatidiform mole because protein is needed
for the development of the trophoblastic villi.
 Women older than 35 years old. Being
pregnant beyond 35 years old presents a lot
of risky conditions like H-mole. (>50 y.o.)
 Asian women. Asians have a higher chance of
acquiring this disease because of their genetic
formation.
 Women with a blood group of A who marry
men with blood group O. these blood groups,
when combined together, results in
unfavorable conditions like H-mole.
 History of earlier H-mole
SIGNS AND SYMPTOMS
These signs and symptoms, if noticed in a pregnant
woman, might indicate a possibility of GTD:
 Uterus expands faster than normal. Because
the trophoblast cells proliferate abnormally, it
does so in such a rapid pace that the uterus
reaches its growth landmarks before the
usual time.
 A very high serum or urine test for hCG.
Trophoblast cells produce hCG, and they are
produced in large amounts because the
trophoblast cells are growing rapidly.
 Vaginal bleeding. (dark brown to bright red)
When the H-mole is still not identified at the
16th week of pregnancy, it will identify itself
through vaginal bleeding accompanied by
clear fluid filled vesicles.
 Nausea and vomiting
 Preeclampsia
 Pelvic pressure/pain
DIAGNOSTIC TESTS
Diagnostic tests are ordered to check for a
presence that might indicate a positive
gestational trophoblastic disease.
 Pregnancy test. This may not be able to
detect specifically the H-mole, but this will
confirm if the woman is pregnant or not.
 Urine test or serum for hCg. A very high result
for hCg might indicate the presence of an H-
mole.
 Transvaginal Ultrasound. An ultrasound will
show a dense growth of grape-like vesicles
with a snowflake pattern, filled with clear
fluid instead of an embryo.
MEDICAL MANAGEMENT
 Methotrexate. Physicians may order a
prophylactic course of methotrexate, which
attacks rapidly growing cells like the
abnormally growing trophoblastic cells.
 Dactinomycin. This is ordered by the
physician once metastasis occurs.
SURGICAL MANAGEMENT
 Suction curettage. This is the ideal
management of gestational trophoblastic
disease, to evacuate the mole inside the
woman’s uterus and avoid any further
complications if it stays longer inside the
reproductive system.
 D&C (Dilation & curettage)
 Removal of the uterus
NURSING MANAGEMENT
 Nurses must also take action during the
critical stages of the pregnancy. We must be
able to function on our own while waiting for
any orders from the physician.
 Monitor hCG
NURSING ASSESSMENT
 Assess the abdominal girth of the pregnant
woman to check if it is within the usual
landmark of pregnancy.
 Assess for signs and symptoms of pregnancy
induced hypertension, because for a woman
with H-mole, they occur earlier than the 20th
week of pregnancy.
 Instruct the woman to save all perineal pads
containing any clots or tissue that has passed
out of her during bleeding.
NURSING DIAGNOSIS
 Grieving related to loss of pregnancy as
evidenced by anger and social detachment.
NURSING INTERVENTIONS
 Measure abdominal girth and fundal height to
establish baseline data regarding the growth
of the uterus.
 Assist patient in obtaining a urine specimen
for urine test of hCg.
 Save all pads used by the woman during
bleeding to check for clots and tissues she
may have discharged.
 Provide your patient with an open
environment and a trusting relationship so
she would be encouraged to express her
feelings.
 Honestly answer the patient’s questions to
foster a trusting relationship between nurse
and client.
 Provide an assurance that it is not her own
fault that this happened to her to lessen her
sense of guilt and self-blame.
EVALUATION
 Patient must be able to express her feelings
effectively.
 Patient must acknowledge the situation and
seek for appropriate help.
 Patient must learn to look forward for the
future step by step.
 The pain a mother experiences at the loss of a
pregnancy is never comparable to any pain in
the world. Expecting for an addition in the
family and losing it before it is even born is a
difficult situation, but somehow we, as
nurses, have the ability to give them comfort
and reduce the pain they are feeling through
COMPLICATIONS
 After removal of H-mole, some tissues/mass
continue to grow
 Persistent GTD: hCG reveals to continue to
increase even after removal of H-mole